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慢性静脉功能不全患者血栓形成风险的实验室评估模型初探OACSTPCD

A laboratory model for evaluating the risk of thrombosis in patients with chronic venous insufficiency

中文摘要英文摘要

目的 探讨联合血栓弹力图(thromboelastography,TEG)、凝血指标和血小板参数评估慢性静脉功能不全(chronic venous insufficiency,CVI)患者血栓形成风险的预测价值.方法 回顾性纳入本院2020 年11 月至2022 年3月共计CVI患者359 名,根据是否发生静脉血栓栓塞症(venous thromboembolism,VTE)分为VTE组和非VTE组.分析2 组的基线特征,以及联合血栓弹力图、凝血指标和血小板参数对CVI患者发生VTE的风险预测价值.采用单因素Logistic回归分析的方筛选风险因子,采用多因素Logistic回归构建预测模型,通过曲线下面积(AUC)、灵敏度、特异度等指标以及临床决策曲线(DCA)进行模型性能评价.结果 对照组相比,血栓形成组R值降低(3.27±0.71 vs 3.87±1.16,P<0.05);凝血酶原时间(PT)降低(11.08±3.02 vs 12.86±3.48,P<0.001),纤维蛋白原(Fib)增高(3.46 vs 3.10,P<0.05),D二聚体(DD)增高(3.00 vs 1.12,P<0.001);血小板分布宽度(PDW)降低(12.01±3.87 vs 13.98±3.20,P<0.001).以PT、DD、R值、Fib和PDW作为预测因子建立的血栓形成预测模型ROC曲线下面积为 0.842 2,灵敏度和特异度分别为 36.78%和 95.59%.临床决策曲线(DCA)判断当模型预测值为 0.1~0.7 时可使患者获益.结论 联合TEG、凝血指标和血小板参数预测CVI患者发生VTE风险具有一定的效果.

Objective To explore the predictive value of combined thromboelastography(TEG),coagulation index and platelet parameters in evaluating the risk of thrombosis in patients with chronic venous insufficiency(CVI).Methods A total of 359 patients with CVI were enrolled in our hospital from November 2020 to March 2022,and divided into VTE group and non-VTE group according to the occurrence of venous thromboembolism(VTE).The baseline characteristics of the two groups and the value of combined TEG,coagulation index and platelet parameters in predicting the risk of VTE in patients with CVI were analyzed.The risk factors were screened by univariate logistic regression analysis,and the prediction model was constructed by multivariate logistic regression.The performance of the model was evaluated by area under the curve(AUC)and sensitivity specificity.Results Compared with the non-VTE group,the R value(3.27±0.71 vs 3.87±1.16,P<0.05),the prothrombin time(PT)(11.08±3.02 vs 12.86±3.48,P<0.001)and the platelet distribution width(PDW)(12.01±3.87 vs 13.98±3.20,P<0.001)of the VTE group decreased,while fibrinogen(Fib)(3.46 vs 3.10,P<0.05)and D-dimer(DD)(3.00 vs 1.12,P<0.001)increased.It was found that the area under the ROC curve of the thrombosis pre-diction model based on PT,DD,R value,Fib and PDW was 0.842 8,with the sensitivity and specificity of 36.78%and 95.59%,respectively.The decision curve analysis(DCA)indicated that patients would benefit when the model's predicted probability ranged from 0.1 to 0.7.Conclusion The combination of TEG,coagulation index and platelet parameters is ef-fective in predicting the risk of VTE in patients with CVI.

肖湘;斯雍然;张静薇;曾彦

成都市第二人民医院输血科,四川 成都 610000成都市第二人民医院血液科,四川 成都 610000

临床医学

血栓弹力图慢性静脉功能不全静脉血栓栓塞症风险评估

thromboelastography(TEG)chronic venous insufficiency(CVI)venous thromboembolism(VTE)risk assessment

《中国输血杂志》 2024 (006)

632-637 / 6

四川省自然科学基金项目面上项目(2023NSFSC0550);成都市医学科研项目(2023105)

10.13303/j.cjbt.issn.1004-549x.2024.06.004

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